Crohn's Disease Implications

• The clinical course of Crohn's disease over time
• The development of complications
• The emotional cost to patients
• Time to diagnosis

The clinical course of Crohn's disease

The graph below illustrates the lifetime clinical course of Crohn's disease (CD), breaking it down by disease state.¹

Five years after diagnosis:

• The proportion of patients:
  • in medical remission decreases to about 30%
  • with mild disease increases to 35%
• Only a small proportion of patients require surgery or are receiving corticosteroids or immunosuppressive medication
• A high proportion of patients are in "postsurgery remission"

The development of complications

Most patients with high and chronic disease activity will develop a stricturing or penetrating (fistulizing) complication. This can impact hospitalization and surgical costs.²

The Kaplan-Meier chart below is from a retrospective study assessing the long-term disease progression of CD in more than 2000 patients. The graph illustrates the probability of patients remaining free of penetrating (upper curve), stricturing (middle), and inflammatory (lower curve) complications.²

The emotional cost to patients

The symptoms and complications of CD can greatly affect the quality of life of an individual, including physical and emotional well-being, social functioning, and self-image.³ In the Voices of Crohn's Survey, patients with Crohn's disease reported that the disease significantly impacts their personal and professional lives. In fact, 93% of Crohn's patients surveyed felt that the disease has an impact on their overall emotional well-being.⁴

Time to diagnosis

Patients with CD often wait more than 3 years before being properly diagnosed, often resulting in frustration to the patient. Additionally, 75% of patients felt that physicians and employers were in need of increased awareness about CD.⁴

References:

1. Silverstein MD, Loftus EV, Sandborn WJ, et al. Clinical course and costs of care for Crohn's disease: Markov model analysis of a population-based cohort. Gastroenterology. 1999;117:49-57.
2. Cosnes J, Cattan S, Blain A, et al. Long-term evolution of disease behavior of Crohn's disease. Inflamm Bowel Dis. 2002;8:244-250.
3. Crohn's Disease and Ulcerative Colitis: Emotional Factors. Crohn's and Colitis Foundation of America. Available at: http://www.ccfa.org/frameviewer/?url=/media/pdf/emotional.pdf&LMI=2.1. Accessed November 30, 2008.
4. Voices of Crohn's Key Findings. Available at:
   http://www.voicesofcrohns.com/voicesofcrohns/
   pages/voices/key_findings.jsp. Accessed November 30, 2008.